Midazolam and Ketamine for Convulsive Status Epilepticus in the Out-of-Hospital Setting.
Annals of Emergency Medicine · 2024-12-13 · Observational study
Abstract
STUDY OBJECTIVE: To determine if ketamine, when added to midazolam for the treatment of out-of-hospital seizures, is associated with an increase in the rate of cessation of convulsions prior to hospital arrival. METHODS: We performed a retrospective cohort study of out-of-hospital patients with an active convulsive seizure being transported to a hospital by a large emergency medical services system in Florida, using data from August 1, 2015 and August 5, 2024. Per protocol, patients received midazolam first for their seizure. Starting in June 2017, a new protocol was developed in which patients who continued to convulse after midazolam received ketamine. We used propensity score matching and multivariable logistic regression to determine if patients who received ketamine were more likely to stop convulsing prior to hospital arrival than those who received midazolam alone. RESULTS: Overall, 479 (80.1%) of 598 actively convulsing patients who received 2 doses of midazolam (without subsequent ketamine) had resolution of their convulsions prior to hospital arrival compared with 85 (94.4%) of 90 who received ketamine after midazolam, an absolute difference between groups of 14.3% (95% CI 8.6% to 20.1%). After propensity matching, 82.0% of those in the midazolam only group had resolution of convulsions compared to 94.4% in the ketamine group, a difference of 12.4% (95% CI 3.1% to 21.7%). CONCLUSION: In this retrospective study of out-of-hospital patients with active convulsive seizures, patients who received ketamine were more likely to have stopped convulsing prior to hospital arrival than those who received midazolam alone.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Anaesthetics · Sedatives & anxiolytics · Ketamine · Midazolam
Related articles
- [S2k guidelines: status epilepticus in adulthood : Guidelines of the German Society for Neurology]. (Nervenarzt, 2021)
- Standards of care for adults with convulsive status epilepticus: Belgian consensus recommendations. (Acta Neurol Belg, 2005)
- Combined Ketamine and Midazolam Versus Midazolam Alone for Initial Treatment of Pediatric Generalized Convulsive Status Epilepticus (Ket-Mid Study): A Randomized Controlled Trial. (Pediatr Neurol, 2025)
- Effectiveness of Ketamine As a Rescue Drug for Patients Experiencing Benzodiazepine-Resistant Status Epilepticus in the Prehospital Setting. (Crit Care Explor, 2024)
- Evaluation of the Use of Ketamine in Prehospital Seizure Management: A Retrospective Review of the ESO Database. (Prehosp Emerg Care, 2025)
- EFNS guideline on the management of status epilepticus in adults. (Eur J Neurol, 2010)